Application contents - California Department of Web viewMark "ORIGINAL" on the cover of your application package, ... (formerly Office of Management and Budget (OMB) Circular A

CALIFORNIA DEPARTMENT OF TRANSPORTATION CALIFORNIA DEPARTMENT OF TRANSPORTATION DIVISION OF MASS TRANSPORTATIONDIVISION OF MASS TRANSPORTATIONRural Transit and Intercity Bus BranchRural Transit and Intercity Bus Branch

FEDERAL TRANSIT ADMINISTRATION (FTA)

FEDERAL FISCAL YEAR 2012FEDERAL FISCAL YEAR 2012SECTION 5311 CAPITAL VEHICLE

& EQUIPMENT APPLICATION

Name of Subrecipient:

Address:

City/State/Zip Code:

Contact Person: Title:

Phone: E-Mail:

DUNS Number: CCR Number:

Funding Program:5311 or CMAQ

FTA Amount of Funds Requested: $

California Department of TransportationDivision of Mass Transportation, MS 39

P.O. Box 9428741120 N Street, Room 3300

Sacramento, CA 95814http://www.dot.ca.gov/hq/MassTrans/5311.html

DMT Mainline (916) 654-8811

http://www.dot.ca.gov/hq/MassTrans/5311.html

GENERAL INSTRUCTIONSSTATE OF CALIFORNIA

FTA SECTION 5311 PROJECT CAPITAL (VEHICLE& EQUIPMENT) APPLICATION

1. Mark "ORIGINAL" on the cover of your application package, which contains the master copy of the requested documentation with original “wet” signatures. Note: We also accept a notarized copy of the application if you cannot submit the original application.

2. Submit one original and one copy of application, as well as the Program of Project (POP) to your District Transit Representative (DTR).

3. The DTR will:

a. Review the application for completeness using the DTR application checklist, and may contact the agency for questions and clarification to improve the application.

b. Forward the original application and the completed DTR application checklist to headquarters (HQ) liaison.

4. Applications must be complete and final as submitted. Note: Incomplete applications will be returned to the applicant for revision.

5. The project will NOT be included in the FTA Section 5311 grant until the complete application package is received.

6. The application format is provided in a Word document.

7. Review glossary for terms used throughout the application.

Application Checklist/Table of Contents

Subrecipient: County/Region:

Federal Share $ Local Share $ Contact DTR._______________________

Funding Source (check one):

5311 Regional Apportionment: CMAQ or STP Flexible Funding:

Table of Contents: Checklist (Return Applicable Items to Caltrans)

1. Program Overview/Goals

2. Eligibility

3. PART I – Certifications and Assurances of the Subrecipient

4. PART II - Certifications and Assurances of The Regional Transportation Planning Agency

5. PART III – Project Description

6. PART IV – Project Budget Worksheet (Subrecipient)

7. PART V – Project Budget

8. PART VI – Labor Union Information

9. PART VII – Coordination of Services with Social Service Agencies

10. PART VIII – Transit Security and Emergency Preparedness

11. PART IX – Public Hearing

12. PART X –Civil Rights

13. PART XI –Disadvantage Business Enterprise (DBE)

14. PART XII - Authorizing Resolution

15. PART XIII - IT/ITS Compliance Plan

16. PART XIV - Maintenance Plan Checklist

FTA Annual Certifications and Assurances

Copy of POP signed by the certifying representative of MPO

Copy of Federally Approved TIP (If applicable)

Copy of FHWA/FTA Federally Approved TIP

Copy of Bid Related Documents for Capital contracts (If applicable)

Glossary

Application Prepared By: Phone:

Page 3 of 27

PROGRAM OVERVIEW/GOALSSTATE OF CALIFORNIA


Federal Transit Administration (FTA) Section 5311 is a program that is formula based and provides funding to states for the purpose of supporting public transportation in rural areas. Rural areas encompass all populations, housing, and territory not included within an urbanized area of 50,000 or more population. Counties and regions may be entirely rural, or they may be composed of rural areas and one or more urbanized areas. The goal of the 5311 program is to provide the following services to rural areas:

Enhance the access of people in nonurbanized areas to health care, shopping, education, employment, public services, and recreation;

Assist in the maintenance, development, improvement, and use of public transportation systems in nonurbanized areas;

Encourage and facilitate the most efficient use of all transportation funds used to provide passenger transportation in nonurbanized areas through the coordination of programs and services;

Assist in the development and support of intercity bus transportation; and

Provide for the participation of private transportation providers in rural areas.

ELIGIBILITYSTATE OF CALIFORNIA


Eligible Recipients:

Section 3013 (s) of the Safe, Accountable, Flexible, Efficient Transportation Equity Act: A Legacy for Users (SAFETEA-LU), amended eligible recipients to include a State or Indian tribe that receives a federal transit program grant directly from the Federal Government. A subrecipient of the program includes a State or local governmental authority, a nonprofit organization, or an operator of public transportation or intercity bus service that receives federal transit program grant funds.

Eligible Capital Activities (Vehicles & Equipment):

Capital expenses include buses, vans, radios and communication equipment, fareboxes, wheelchair lifts and restraints, passenger shelters, operational support such as computer hardware/software and minor construction or rehabilitation of transit facilities. In addition, vehicle inspection fees are eligible capital expenses. Another category of capital expenses is transit related “intelligent transportation system” (ITS) equipment. Examples include automated vehicle locator systems, scheduling software, information kiosks, etc.). ITS projects must be consistent with the Regional Architecture Plan. See page 21, #5 of this application. Subrecipients are expected to comply with procurement schedule as stated in page 11, Part III, Project Description, #13 of this application. Vehicle specifications must be reviewed and approved by DMT staff prior to purchase. See Caltrans DMT Federal Vehicle Procurement Process at http://www.dot.ca.gov/hq/MassTrans/Procurement-Grants-Management.html for more information.

Page 4 of 27

PART I - CERTIFICATIONS AND ASSURANCESSTATE OF CALIFORNIA


General Information:

Name of Applicant:

Certifications and Assurances:

1. Pursuant to 49 Code of Federal Regulations (CFR), Part 21, Title VI of the Civil Rights Act of 1964 , the subrecipient assures that no person, on the grounds of race, color, creed, national origin, sex, age, or disability shall be excluded from participation in, or denied the benefits of, or be subject to discrimination under any project, program or activity funded in whole or in part by Federal Transit Administration (FTA).

2. Pursuant to 49 CFR, Part 21, Title VI of the Civil Rights Act of 1964 , the subrecipient assures that it shall not discriminate against any employee or subrecipient for employment because of race, color, religion, sex, national origin, and that it shall take affirmative action to ensure that subrecipients are employed, and that employees are treated during employment, without regard to their race color, religion, sex, or national origin.

3. Pursuant to 49 CFR, Part 27, U.S. DOT Regulations implementing the Rehabilitation Act of 1973 , the subrecipient certifies that it will conduct any program or operate any facility that receives or benefits from Federal financial assistance administered by FTA in compliance with all imposed requirements, Nondiscrimination on the basis of Handicap in Programs and Activities Receiving or Benefiting from Federal Financial Assistance.

4. Pursuant to 49 CFR, Part 26 , the subrecipient must prepare and maintain complaint procedures for investigating and tracking Title VI complaints filed against them. Such procedures include record of investigations, complaints, and/or lawsuits, and notice to the public about rights containing instructions on how to file a discrimination complaint. Recipients of federal financial assistance are required to take reasonable steps to ensure meaningful access to their programs and activities by limited English proficient persons.

5. Pursuant to 49 CFR Part 21 , the subrecipient certifies that special efforts are being made to provide the level and quality of transportation services that disabled persons, including wheelchair users and semi-ambulatory persons, can use. This transportation shall be reasonable in comparison to the transportation provided to the general public and shall meet a significant fraction of actual transportation needs of such persons within a reasonable time.

6. The subrecipient assures and certifies that it will comply with the Federal statutes, regulations, executive orders and administrative requirements, which relate to applications made to and grants received from FTA. The subrecipient acknowledges receipt and understanding of the list of such statutes, regulations, executive orders and administrative requirements that is provided in FTA Circular 9040.1F.

7. The subrecipient agrees and assures that it will comply with U.S. DOT regulations, “Participation by Disadvantaged Business Enterprises (DBE) in Department of Transportation Financial Assistance Programs,” 49 CFR part 26. Among other provisions, this regulation requires recipients of DOT Federal financial assistance, namely State and local transportation agencies, to establish goals for the participation of disadvantaged entrepreneurs and certify the eligibility of DBE firms to participate in their DOT-assisted contracts. The recipient agrees and assures that it will comply with 49 CFR 26.49 which requires each transit vehicle manufacturer, as a condition of being authorized to bid or propose a FTA-assisted

Page 5 of 27

transit vehicle procurement (new vehicles only), certify that it complied with the requirements of the DBE program.

8. The subrecipient assures and certifies that it will adhere to the California State DBE Program Plan as it applies to local agencies. The subrecipient must complete and submit to the Department a DBE Implementation Agreement. The subrecipient certifies that it must report twice annually on DBE participation in their contracting opportunities; their award/commitments and actual payments.

9. The subrecipient assures and certifies that its services funded by Section 5311 are, and shall remain, open to the general public.

10. The subrecipient certifies that its procurements and procurement system will comply with all applicable requirements imposed by Federal laws, executive orders, or regulations and the requirements of FTA Circular 4220.1F, “Third Party Contracting Requirements,” and such other implementing requirements as FTA may issue. The subrecipient certifies that it will include in its contracts, financed in whole or in part with FTA assistance, all clauses required by Federal laws, executive orders, or regulations and will ensure that each sub recipient and each contractor will also include in its sub agreements and contracts financed in whole or in part with FTA assistance all applicable contract clauses required by Federal laws, executive orders, or regulations.

11. The subrecipient assures and certifies that private for-profit transit operators have been afforded a fair and timely opportunity to participate to the maximum extent feasible in the planning and provision of the proposed transportation services.

12. The subrecipient certifies that it has established and implemented an anti-drug and alcohol misuse prevention program and has conducted employee training complying with the requirements of 49 CFR part 655, “Prevention of Alcohol Misuse and Prohibited Drug Use in Transit Operations”.

13. The subrecipient assures and certifies that it requires its subcontractors and sub-recipients to have established and implemented an anti-drug and alcohol misuse prevention program, to have conducted employee training complying with the requirements of 49 CFR part 655, “Prevention of Alcohol Misuse and Prohibited Drug Use in Transit Operations”.

14. The subrecipient certifies that before expending any Federal assistance to acquire any new bus model or any bus model with a new major change in configuration or components or before authorizing final acceptance of that bus (as described in 49 CFR part 665), that model of bus will have been tested at a bus testing facility approved by FTA and subrecipient and FTA will have received a copy of the test report prepared on that bus model.

15. Subrecipients are not subject to the charter rule when using FTA-funded vehicles to provide public transportation or coordinated human service transportation or to serve groups of individuals with disabilities, the elderly, or low income individuals. The charter rule does apply, however, if the FTA recipient wants to provide other charter service using FTA-funded vehicles. Subrecipients providing charter service under exceptions 604.6 government officials, 604.7 qualified human service agencies, 604.8 leasing, and 604.9 no response from a registered charter provider must report trip information to FTA.

16. As required by 49 U.S.C. 5323 (f) and FTA regulations, “School Bus Operations,” at 49 CFR 605.14, the subrecipient agrees that it and all its recipients will: (1) engage in school transportation operations in competition with private school transportation operators only to the extent permitted by an exception provided by 49 U.S.C. 4323 (f) and implementing regulations, and (2) comply with requirements of 49 CFR part 605 before providing any school transportation using equipment or facilities acquired with Federal assistance awarded by FTA and authorized by 49 U.S.C. Chapter 53 or Title 23 U.S.C. for

Page 6 of 27

transportation projects. The subrecipient understands that the requirements of 49 CFR part 605 will apply to any school transportation it provides, that the definitions of 49 CFR part 605 apply to any school transportation agreement, and a violation of this agreement may require corrective measures and the imposition of penalties, including debarment from the receipt of further Federal assistance for transportation.

17. The subrecipient assures and certifies that when procuring capital equipment acquired with Federal assistance it will comply with all Buy America provisions as pertaining to all 5311 subrecipients, 49 CFR Part 661 and 49 USC 5323(j)(2)(c). This policy means that certain steel, iron, and manufactured products used in any capital equipment acquired with Federal assistance must be produced in the United States. Buy America requirements apply to all purchases, including materials and supplies funded as operating costs, if the purchase exceeds the threshold for small purchases (currently $100,000).

18. The subrecipient certifies that it will comply with the requirements of 49 CFR parts 663, in the course of purchasing revenue rolling stock. The subrecipient will conduct, the prescribed pre-award and post-delivery reviews of rolling stock purchased and will maintain on file the certifications required by 49 CFR part 663, subparts B, C, and D.

19. The subrecipient certifies that it will submit the “FTA Annual List of Certifications and Assurances for Federal Transit Administration Grants and Cooperative Agreements” before March 31 annually.

20. The subrecipient has provided documentation needed by the Department to assure FTA that it has properly and sufficiently delegated and executed authority, by Resolution, to the appropriate individual(s) to take official action on its behalf.

21. The subrecipient, providing complimentary paratransit service, certifies that it has submitted to the Department an initial plan for compliance with the complimentary paratransit service provision by January 26, 1992, as required by 49 CFR Part 37, Section 135(b) and has provided the Department annual updates to its plan on January 26 of each year, as required by 49 CFR Part 37, Section 139(c). The subrecipient has provided the Department an initial plan.

22. The subrecipient certifies that all direct and indirect costs billed are allowable per Title 2 Code of Federal Regulations, Part 225 (2 CFR 225) (formerly Office of Management and Budget (OMB) Circular A–87), the federal guidelines for allowable costs for subrecipients that are State, Local and Indian Tribal governments or 2 Code of Federal Regulations, Part 230 (2 CFR 230), (formerly, OMB Circular A–122) if the subrecipient is a non-profit organization. With regards to private for-profit organizations, see 48 CFR Part 3.

23. The subrecipient certifies that all indirect costs billed are supported by an annual indirect cost allocation plan submitted in accordance with 2 CFR 225. The plan or subrecipients’ cognizant agency approval of the plan was submitted to the Department’s Division of Audits and Investigations and approved before subrecipient submits request for reimbursement of any indirect costs. Indirect costs prior to having a plan approved as evidenced by a letter from the Departments’ Division of Audits and Investigations is not an allowable expense. If subrecipient does not bill for indirect cost then an indirect cost allocation plan is not required.

24. Before a subrecipient may lease an asset, FTA regulations, “Capital Leases,” 49 CFR 639, Subpart C, require a written comparison of the cost of leasing the asset compared with the cost of purchasing or constructing the asset. Costs used in the comparison must be reasonable, based on realistic current market conditions, and based on the expected useful service life of the asset.

25. The subrecipient certifies that it understands that Transit Employee Protection is specified in Title 49 U.S.C. 5333(b). This Title requires that the interests of employees affected by assistance under most FTA programs shall be protected under arrangements the Secretary of Labor, and concludes that they are fair

Page 7 of 27

and equitable. Title 49 U.S.C. 5311(b) requires that the Department of Labor (DOL) use “a special warranty that provides a fair and equitable arrangement to protect the interests of employees” in order for the 5311(i) requirements to apply to Section 5311.

26. The subrecipient certifies that it has a written maintenance plan for FTA funded vehicles, equipment, and facilities, as required by FTA Master Agreement Section 19.c, 49 CFR 37.161, FTA C 5010.1D, Chapter II, Section 3.a(11) and Chapter IV, Section 3.m.

Certifying Representative:By signing below, I have read and acknowledged that my agency is in compliance with certifications and assurances as stated above.

(Please Print)Name: Title:

Signature: Date: (Original signature in BLUE ink)

Page 8 of 27

PART II – CERTIFICATIONS AND ASSURANCES OF THE REGIONAL AGENCY/TRANSPORTATION PLANNING AGENCY (TPA)

STATE OF CALIFORNIAFTA SECTION 5311 PROJECT CAPITAL (VEHICLE& EQUIPMENT) APPLICATION

Name-Regional Agency/TPA: Contact Person: Title:

Phone: E-Mail: Name of Subrecipient:

Project Description:

Project Amount and Fund TypeRegional Apportionment 5311

Flexible Fund CMAQ or STP*

Toll Credit**

$ $ % $ * CMAQ projects may be equal up to 100% at the discretion of the Regional Planning Agency Certification per Part II.** Prior approval by Caltrans required.

Federal Transportation Improvement Program - Metropolitan Planning Organizations/Regional Transportation Planning Agency

Document (or Amendment)Number Document (or Amendment) Year

FHWA/FTA FederallyApproved TIP (Date)

Check all that apply: Flexible Funded Projects Only - Please initiate the transfer of funds to Grant CA-85-X00X.

(Following the transfer of flexible funds to the FTA, this agency agrees to comply with the applicable terms and conditions set forth in Title 49, U.S. Code, Chapter 53, “Mass Transportation”, and the policies and procedures stated by the FTA relative to the above designated project.)

Some combination of state, local, or private funding sources have been or will be committed to provide the required local share.

The subrecipient has coordinated with other transportation providers and users in the region, including social service agencies capable of purchasing service.

The amount requested does not exceed the Federal funds provided to this agency in the approved Federal TIP/Federal Statewide TIP(FSTIP)

The regional agency/TPA has approved, by resolution, the programming of funds for this Project and Project has met all Statewide Transportation Improvement Program (STIP) requirements.

Certifying Representative:By signing below, I have read and acknowledged that my agency is in compliance with certifications and assurances as stated above.



Page 9 of 27

PART III – Project Description STATE OF CALIFORNIA


Answer the following questions regarding the project description and the operational plan:

1. Indicate the type(s) of public transportation service for the proposed project funded by FTA Section 5311. (Check all that apply.)

Fixed route – Vehicles will travel on specific roads and stop at pre-designated locations according to a schedule. Demand-response – Vehicles will pick people up when they need a ride. Deviated fixed route – Vehicles will travel from point A to point B but go out of the way to pick up or drop off people if necessary. ADA paratransit service.

2. Please indicate the geographic area your agency serves. (If your agency serves both rural and urbanized areas, please attach the route map to this application to clearly indicate that 5311 funds will be spent on the rural area’s route(s)/service only.)

Rural area only (population under 50,000)Both rural and urbanized areas (Population more than 50,000)

List all cities and counties served by your project:__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

If your agency serves both rural and urbanized areas, please describe the cost allocation methodology your agency uses to segregate rural service costs funded by 5311 from the urbanized service costs funded by Section 5307 or other urban funds and attach the cost allocation plan to this application:__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

3. Please fill out the following:

At a minimum, transportation service shall be provided between __AM to ___PM from ___DAY to ___DAY.

4. For the FY you are applying for, did your agency receive any other FTA funds that would be utilized on this project? (Check all that apply and provide standard agreement #s and dollar amount.) **For 5307, the term “receive” means funds have been obligated, and for 5310, 5316 & 5317, the term “receive” means your agency received an executed standard agreement from Caltrans.

No5310 (Elderly and Disabled Specialized Transit Program) SA# __________ $___________5316 (Job Access and Reverse Commute Program) Grant# or SA# __________ $___________5317 (New Freedom Program) Grant# or SA# __________ $___________5307 (Urbanized Area Formula Program) $___________Other FTA funds. Specify: _____________________________________ $___________

5. The proposed capital purchase is for:

Page 10 of 27

Vehicle(s) (Attach one quote or purchasing schedule with the options highlighted and Go to question #5)Non- ITS Equipment (Attach 3 estimates of like-kind equipment with this application & Go to question #8)Information Technology (IT)/Intelligent Transportation Systems (ITS) Equipment (i.e. Hardware, Software, fareboxes, GPS, AVL, Smart Cards, and Vehicle Maintenance System. Fill out IT/ITS form, attach 3 estimates of like-kind equipment & Regional ITS Architecture Plan with this application & Go to question #8)

5. Indicate the type of the proposed vehicle purchase:

Vehicle Replacement (Go to question #6, then #7)Service Expansion (Go to question #7)

6. List the current vehicle(s) that will be replaced:Type (Bus, Van, Trolley, etc.)

Class (Type I, III, VII, etc)

Fuel Type Length Passenger Capacity

VIN # Vehicle Age

Mileage

7.List the vehicle(s) your agency proposes to purchase (Go to question #9):Quantity Type (Bus, Van,

Trolley, etc.)Class (Type I, III, VII, etc)

Fuel Type

Length Passenger Capacity

Unit cost Total cost

*Note: Manufactured vehicles shall not exceed the Original Equipment Manufacturers Gross Vehicle Weight Rating.

8. List the equipment your agency proposes to purchase:Quantity Description of the equipment (fareboxes, AVL,

GPS, etc)Unit cost Total Costs

9.What is the need for this vehicle/equipment? How did you select the project?

i. Describe what service improvements would be addressed by acquiring the equipment and/or vehicles?

ii. If your agency is requesting vehicle(s) replacement, explain why the vehicle(s) replacement is needed.

iii. If the request for vehicle(s)/equipment is for service expansion, how was the need for the expansion determined?

iv. If funding for this project is approved, how will the surrounding community benefit?

Page 11 of 27

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

10. How is your project service marketed? (Check all that apply.)

Newspaper Radio FlyerSurvey TV/Cable Other Specify:________________________

11. Do you intend to lease this 5311 funded vehicle(s)/equipment?

Yes No

12. What is your proposed method of procurement?

Local Procurement (Attach RFP/IFB/RFQ and Bid Package to this application)Three-like kind bids/quotes (Attach three-like kind bids/quotes to this application)Non-Local Procurement/Piggyback (Attach assignability letter and *Piggyback Worksheet to this

application)Sole Source (Attach *Sole Source Justification to this application)Other Specify:_______________________

*Piggyback Worksheet and Sole Source Justification can be found at http://www.dot.ca.gov/hq/MassTrans/Procurement-Grants-Management.htmlFor more detailed information regarding procurement, please see FTA Section 5311’s Procurement Handbook.

13. Fill out the proposed procurement schedule:Procurement Schedule DateBid Package to CaltransIssue Purchase Order to VendorDelivery/InstallationPlace into Service

14. Does your agency receive more than $500,000 in federal funds?

Yes No

15. Does your agency employ more than 50 transit-employees (including temporary, full time or part time employees either directly employed and/or through contractors) and receive more than $1 million in capital or operating assistance?

*Note: At all times while the PROJECT property is in the possession or control of the subrecipient, the subrecipient shall be the registered owner and STATE shall be the legal owner or lien holder. The subrecipient shall not transfer ownership of the PROJECT property at any time while the standard agreement is in effect. As the lien holder, the STATE may take possession of the PROJECT property, as a result of the subrecipient’s non-compliance with contract terms or by mutual agreement between the STATE and the subrecipient. The STATE shall retain the original Certificate of Title until such time that disposition of the PROJECT property is released by the STATE to the subrecipient or other appropriate party as outlined in Exhibit D, Paragraph 4 of the standard agreement.

Page 12 of 27

http://www.dot.ca.gov/hq/MassTrans/Procurement-Grants-Management.html

Page 13 of 27

PART IV –PROJECT BUDGET WORKSHEET (SUBRECIPIENT)STATE OF CALIFORNIA

FTA SECTION 5311 PROJECT OPERATING ASSISTANCE APPLICATION

PROJECT BUDGET WORKSHEET (Subrecipient) The worksheet provides annual expense categories that applicants should use to calculate project eligible expenses for work done “in-house.” The information in this worksheet should be used in completing project budget on page 14.

1. Direct Labor(Job Title/Classification) Description of Task

PerformedHours Hourly Rate Total

2. Direct cost(s) for Employees (Except Labor)

Equipment and Supplies (itemize) _______________________ $ __________________________________ $ __________________________________ $ __________________________________ $ ___________Sub Total $ ___________

3. Other Direct costs (itemize) _______________________ $ __________________________________ $ __________________________________ $ __________________________________ $ ___________Sub Total $ ___________

4. Travel costs (itemize) _______________________ $ __________________________________ $ __________________________________ $ __________________________________ $ ___________Sub Total $ ___________

5. 1Indirect cost(s) (Overhead and Fringe Benefits):Overhead Rate __________% $ ___________

6. Total Costs: $ ___________

1 Must have approved ICAPPage 14 of 27

PART V - PROJECT BUDGET / CAPITALSTATE OF CALIFORNIA


Subrecipient:

Project Description:

ITEM DESCRIPTION(Attach quote or three like-kind bids)

COST

$

$

$

$

$

NET PROJECT COST: $

LOCAL SHARE (Itemize by Fund Source (State, County, & City) & Toll Credit included)*Local Share can NOT be from other Federal DOT funds.) AMOUNT

$

$

$

$

$

TOTAL LOCAL SHARE* = Allowable Percentage % $

TOTAL FEDERAL SHARE*= Allowable Percentage % $

*FUNDING PROGRAM LOCAL SHARE FEDERAL SHARE5311 REGIONAL (Equipment, Shelters, Facilities) 11.47% 88.53%5311 REGIONAL (Vehicles/Preventive Manitenance) 11.47% 88.53%

Project using Toll credit and CMAQ projects may be equal up to 100% at the discretion of the Regional Planning Agency Certification per Part II and prior approval from Caltrans.

11.47% 88.53%

Page 15 of 27

PART VI – LABOR UNION INFORMATION FOR SECTION 13(c) CERTIFICATIONSTATE OF CALIFORNIA


Name of Subrecipient:

Union Representation of Subrecipient’s Employees

Organization Name: Contact Person:

Address: Telephone:

(required) Email :

Other Surface Union Representation of EmployeePublic Transportation Providers If Any

Organization: Contact Person: Address:

Telephone: Contact Person’s Email (Required):





Page 16 of 27

PART VII – DESCRIPTION OF EFFORTS TO COORDINATE SERVICESWITH SOCIAL SERVICE AGENCIES

STATE OF CALIFORNIA FTA SECTION 5311 PROJECT CAPITAL (VEHICLE& EQUIPMENT) APPLICATION

Please answer the following questions regarding the Description of Efforts to Coordinate Services with Social Service Agencies:

1. What human service agencies, employment/training programs, or other transportation providers does your agency coordinate with? __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

2. In your agency’s coordination efforts with social service agencies, check all that apply: Current Practice

Would Consider

Drivers attend safety/sensitivity trainingSharing vehicles with other agenciesProviding information to riders/patrons on other available servicesWorking with CTSA or other agencies to coordinate trips

Utilize pre-paid fare media with other agenciesCoordinate with Medical, CalWorks or Employment Programs

Other:

3. Describe your agency’s role in the human service-public transportation coordination planning efforts?__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

4. Will this service funded by 5311 address gaps and/or barriers identified in the regional public transportation coordination plan or maintain the existing service?

Yes No

5. Has your agency made any efforts to provide information about your agency’s service to human service agencies, the Work Force Center, or other activity centers.

Yes No

Page 17 of 27

PART VIII – Transit Security and Emergency Preparedness STATE OF CALIFORNIA FTA SECTION 5311 PROJECT CAPITAL (VEHICLE& EQUIPMENT) APPLICATION

1. Does your county emergency evacuation plans identify your agency as community responder-transportation provider?

Yes No

2. Vehicle Inventory – Please include all active fleet. (For condition, please use P for poor, F for fair, and E for excellent.) Applicants may attach a spreadsheet that provides the information below.

Make/Model Year Mileage VIN Ambulatory Capacity

Wheelchair Spaces

Condition Original Source of Funding

Estimated Replacement

date

3. What is your seating/tie down capacity to move individuals with disabilities during an emergency situation from schools, neighborhoods, medical facilities, etc? __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

4. Do you participate in transportation infrastructure security/emergency planning, drills/exercises, and/or decision making activities?

Yes No

Page 18 of 27

PART IX – Documentation of Public Hearing Opportunity STATE OF CALIFORNIA FTA SECTION 5311 PROJECT CAPITAL (VEHICLE& EQUIPMENT) APPLICATION

Per FTA Circular 9040.1F IV, 3 & Title 49 USC 5323(b), subrecipient must hold public hearing to receive comments from the public on the proposed capital project.

Please check and provide copy if applicable:

- Municipal Letter of Resolution of Support- Copy of Published Public Hearing Notice- Affidavit of Publication of Public Hearing Notice- Minutes of Public Hearing, Copies of Exhibits and Written Statements

Page 19 of 27

PART X – Civil Rights STATE OF CALIFORNIA

FTA SECTION 5311 PROJECT CAPITAL (VEHICLE & EQUIPMENT) APPLICATION

1. Please indicate the date of your last Title VI report. __________________

2. Subrecipient must describe any lawsuits or complaints that have been received or acted on in the last year relating to Title VI or other relevant civil rights requirements.

The applicant has no lawsuits or complaints received in the last year relating to Title VI or other Civil Rights requirements.

The applicant had lawsuits and/or complaints that were received in the last year relating to Title VI or other Civil Rights requirements. (Attach a report describing the status of lawsuits and/or complaints and how lawsuits and/or complaints were resolved including corrective actions taken.)

PART XI – Disadvantage Business Enterprise (DBE) STATE OF CALIFORNIA

FTA SECTION 5311 PROJECT CAPITAL (VEHICLE & EQUIPMENT)APPLICATION

1. What enforcement mechanisms does the subrecipient use for DBE requirements? Please explain.__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

2. Does the subrecipient require contractors to obtain approval from its DBE Liaison Officer (DBELO) prior to substituting a DBE firm after contract award?

Yes No N/A

3. Does the subrecipient monitor prime contractors to ensure that DBEs are actually performing applicable work on federally funded projects?

Yes No N/A

4. Did the subrecipient receive any complaints or procurement protests alleging that it did not comply with the DBE regulations for federally funded projects?

Yes (Go to question #6 & 7) No

5. What are the subrecipients' processes for handling protests? Please explain. __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

6. Do the complaints indicate any problems with the DBE program?

Yes No

*The following is a link to FTA’s sample DBE program, “Section 26.37 Monitoring and Enforcement Mechanisms” this section gives examples of monitoring and enforcement mechanisms that ensure compliance. http://www.fta.dot.gov/civilrights/dbe/civil_rights_5771.html

Page 20 of 27

PART XII - AUTHORIZING RESOLUTION STATE OF CALIFORNIA FTA SECTION 5311 PROJECT CAPITAL (VEHICLE& EQUIPMENT) APPLICATION

RESOLUTION NO._____________

RESOLUTION AUTHORIZING THE FEDERAL FUNDING UNDER FTA SECTION 5311 (49 U.S.C. SECTION 5311) WITH CALIFORNIA DEPARTMENT OF TRANSPORTATION

WHEREAS, the U. S. Department of Transportation is authorized to make grants to states throughthe Federal Transit Administration to support capital projects for non-urbanized public transportation systems under Section 5311 of the Federal Transit Act (FTA C 9040.1F); and

WHEREAS, the California Department of Transportation (Department) has been designated by theGovernor of the State of California to administer Section 5311 grants for transportationprojects for the general public for the rural transit and intercity bus; and

WHEREAS, [subrecipient] desires to apply for said financial assistance to permit operation of service in [subrecipient’s service area or county]; and

WHEREAS, the [subrecipient] has, to the maximum extent feasible, coordinated with othertransportation providers and users in the region (including social service agencies).

NOW, THEREFORE, BE IT RESOLVED AND ORDERED that the [subrecipient] does herebyauthorize [Name/Title or Title of designated representative], to file and execute applications on behalf of [subrecipient] with the Department to aid in the financing of capital/operating assistance projects pursuant to Section 5311 of the Federal Transit Act (FTA C 9040.1F), as amended.

That [Name/Title or Title or designated representative] is authorized to execute and file allcertification of assurances, contracts or agreements or any other document required by the Department.

That [Name/Title or Title of designated representative] is authorized to provide additionalinformation as the Department may require in connection with the application for the Section 5311projects.

That [Name/Title or Title or designated representative] is authorized to submit and approve requestfor reimbursement of funds from the Department for the Section 5311 project(s).

PASSED AND ADOPTED by the [subrecipient] of the [Sample County], State of California, at aregular meeting of said Commission or Board Meeting held on the ## of [Month], 20## by the following vote:

AYES:NOES:ABSENT:

<<Insert ANY/ALL Pertinent Signatures (as applicable),Titles and Dates>>

(Original signature in BLUE ink)

Page 21 of 27

PART XIII - INFORMATION TECHNOLOGY/INTELLIGENT TRANSPORTATION SYSTEMS COMPLIANCE PLAN


Agency Name: _____________________________________________________Contact Person: _________________________ Phone: __________________________Email: __________________________________________Address: __________________________________________________________

Please answer all questions. If a question is not applicable to your purchase, write N/A.

Description of the Project – Please answer the following:

1.Briefly describe the following:a. Item(s) being purchasedb. The business function(s) or process the items will supportc. How the item(s) will be used

2. Indicate whether the project requires one or more of the following, estimate the percentage of each: Commercial-off-the-shelf (COTS) No Yes Percentage_____ Modified-off-the-shelf (MOTS) No Yes Percentage_____ Custom software/hardware development (CSD) No Yes Percentage_____

(NOTE: COTS = computer software, hardware, technology, or computer products that are ready-made and available for sale, lease, or license to the general public. MOTS = computer software, hardware, technology, or computer products that can be purchased and then modified by the customer, vendor, third party to meet the specific need/use. CSD = Software and/or hardware is procured from a customized scope of work developed by the agency.)

3. Is the project a proprietary system? No Yes

4. If the IT/ITS system is a MOTS or a CSD, the agency must retain all rights to software development, i.e. “intellectual property rights” funded by the grant. Please verify.

5. Please describe in detail how the project is consistent with your Local or Regional ITS Architecture Plan and based on the requirements of the National ITS Architecture? (National ITS Architecture provides a common framework for planning defining, and integrating intelligent transportation systems. Please provide a copy of the page that indicates your project is included in the local/regional ITS Architecture Plan. For more information, go to http://www.iteris.com/itsarch/.)

6. Please provide the contact information for the agency in charge of the Local or Regional ITS Architecture Plan:

Contact Name _______________________________________Title _______________________________________Telephone Number _______________________________________E-mail _______________________________________

7. Indicate whether the project requires integration or whether the project is a stand-alone system with minimal integration.

Page 22 of 27

http://www.iteris.com/itsarch/

8. If the project requires integration, what systems will be integrated?

9. What other entities (public or private) will be a part of the systems integration?

10. If the agency plans to integrate systems now or in the future, is the agency coordinating this IT/ITS project with a Local or Regional ITS plan?

11. Data Collection:a. Does the agency intend to collect data with their IT/ITS System?b. If so, what do they intend to use the data for?c. If the agency plans to collect data, is it for public use or private use or both?d. If another public or private entity is interested in their data, will they give the

data away for free or charge a fee for it?

12. Does the agency have a license for use? No Yes If multiple systems are to be integrated, do all entities have a license for use, an

agreement, permit, or approval by the vendor?

13. Briefly describe the implementation plan for the procurement of the IT/ITS Project as follows: Procurement Schedule System Maintenance Plan Type of Warranties and Length of Warrantees Training Plan

14. List any special hardware devices or equipment this system must interface or “connect to” and how this special hardware will be interfaced with the project equipment.

15. Describe your agency’s policies to protect the federal investment through its useful life and measures that will be taken to ensure adequate system performance to minimize repairs and replacements.

16. Describe how the agency will administer and manage the acquisition once a contract is awarded.

17. Has your agency established a process for the systems engineering analysis of ITS projects? No Yes

Certifying Representative:

By signing below, I have read and acknowledged that my agency is in compliance with National ITS Architecture, PL 105-178 Section 5206(e), Federal Register, January 2, 2001 (Volume 66, No. 5, pp 1455-1459).



Page 23 of 27

PART XIV - REVIEW CHECKLIST FOR SUBRECIPIENT’S VEHICLE MAINTENANCE PLAN


Answer the following questions regarding the vehicle maintenance plan:

1. Does your agency have a current written vehicle maintenance plan for all FTA funded rolling stock?

Yes No

2. Does the vehicle maintenance plan include goals and objectives? (Page ______)

Yes No

3. Does your agency have a preventive maintenance checklist for all FTA funded rolling stock?

Yes No

4. Are the maintenance plan and preventive maintenance checklist consistent with the current operating fleet?

Yes No

5. Are the maintenance plan and preventive maintenance checklist consistent with manufacturer’s minimum maintenance requirements under warranty?

Yes No

6. How does your agency track the manufacturer’s recommendations and updates on requirements?

7. What is your agency’s schedule for vehicle preventive maintenance? Are they completed on time?

8. Does your agency’s vehicle maintenance plan address maintenance procedures for wheelchair lifts and other accessibility features? (Page ______)

Yes No

9. Do maintenance records indicate that other accessibility features (e.g. kneelers, ramps, etc.) are maintained in operative condition?

Yes No

Page 24 of 27

FTA SECTION 5311 GLOSSARY STATE OF CALIFORNIA FTA SECTION 5311 PROJECT CAPITAL (VEHICLE& EQUIPMENT) APPLICATION

ADA - Americans with Disabilities Act, this Federal law is a comprehensive civil rights measure prohibiting discrimination against the disabled in employment, housing and transportation. The intent of ADA is to ensure equal access for persons with disabilities to public accommodations, public services, telecommunications and transportation.

Annual Certification and Assurances -Subrecipients are required to complete FTA’s Certs and Assurances annually for all FTA grants and cooperative agreements. FTA updates the assurances in January every year. Subrecipients must download the forms from FTA or Caltrans’ website. The signature page must be completed, signed and returned to Caltrans with the application. Subrecipients receiving both 5311 and 5307 funds may submit a hard copy of the Certs and Assurances submitted to FTA.

Authorized Resolution by Planning Agency and/or Subrecipients - The resolution must identify the Section 5311 program and designate all individuals authorized to submit/sign applications, contractual documents (standard agreements), and request for reimbursements. The resolution must cover the following:

Planning agency has approved the programming of funds for this project. Some combination of state, local, or private funding sources has been or will be committed to

provide the required local share. The subrecipient has, or will have by the time of delivery, sufficient funds to operate the vehicles

and equipment purchased under this project or operate the service, as applicable. The subrecipient has coordinated with other transportation providers and users in the region,

including social service agencies capable of purchasing service.

Charter Service – Transportation provided by a recipient at the request of a third party for the exclusive use of a bus or van for a negotiated price, such as:

A third party pays the transit provider a negotiated price for the group; (Any fares charged to individual members of the group are collected by a third party; The service is not part of the transit provider¡¦s regularly scheduled service, or is offered for a

limited period of time; or A third party determines the origin and destination of the trip as well as scheduling; or

Transportation provided by a recipient to the public for events or functions that occur on an irregular basis or for a limited duration and:

A premium fare is charged that is greater than the usual or customary fixed route fare; or The service is paid for in whole or in part by a third party.Note: Charter Service does NOT include demand response services to individuals.

Copy of FTIP/Copy of FHWA/FTA Federally approved TIP Letter - Before FTA can make grants available to recipients, adequate planning must take place. The project proposed must be a product of the metropolitan planning process and/or the statewide planning process specified in 49 CFR part 613 and 23 CFR part 450. That is, all transit projects for which federal funds are expected to be used and that are within metropolitan planning boundaries must be included in a Metropolitan Transportation Improvement Program (TIP) approved by the MPO and the Governor and in a Statewide Transportation Improvement Program (STIP) that has been approved by FTA and the Federal Highway Administration (FHWA). Projects not within metropolitan planning boundaries are required only to be in the STIP. The application should identify the latest approved STIP (or amendments) containing the project(s), the appropriate page numbers, and a statement identifying the date that FTA and FHWA approved the STIP (or STIP

Page 25 of 27

amendment) that contains the proposed project(s). Projects listed in the TIP and STIP must be derived from and consistent with the State’s long range plan.

Fringe Benefits – Compensation in addition to direct wages or salaries, such as company car, house allowance, medical and dental insurance, paid holiday, pension plans, subsidized meals, etc.

Indirect Costs - Indirect costs are overhead costs incurred by subrecipients as a result of the project, but that are not easily identified with the specific project. Generally, indirect costs are defined as administrative or other expenses that are not directly allocable to a particular activity or project; rather they are related to overall general operations and are shared among projects and/or functions. Indirect costs are sometimes referred to as “overhead costs.”

Indirect Cost Allocation Plan (ICAP)- If subrecipients are planning to charge indirect costs to an operating project, you must submit a plan documenting how charges were calculated and allocated between programs and projects. The plan MUST be reviewed and approved in writing by Caltrans Division of Audits and Investigation as well as FTA. Otherwise, Caltrans will NOT reimburse indirect operating expenses.

In-kind Match - In-kind match are goods and services donated from outside your agency. The value of non-cash charges for real property and equipment, and the value of goods and services must be directly benefiting and specifically identifiable to the project. To be eligible as a match, the monetary value of the in-kind contributions must be documented.

In-kind Valuation Plan - If subrecipients are planning to use in-kind match for local share, you must submit a plan documenting a list of donated goods and services, the fair market value of such goods and services and how the values were determined. The plan MUST be approved by Caltrans DMT as well as FTA. Otherwise, Caltrans will NOT issue a standard agreement for your proposed project.

Labor Union Information - Under the terms of the Special Section 13 (c) Warranty for Application to the Small Urban and Rural program, Caltrans must provide an accurate up-to-date listing of all existing transportation providers in the transportation service area of the project, and any labor organization representing employees of such providers to the Department of Labor.

Project Description – As identified in the Program of Projects. Other Providers – Provide a listing of all surface public transportation providers in the

subrecipient’s service area. Union Representative of Subrecipient’s Employees – List union representation including name of

organization, contact person, address, telephone number, and email address or indicate “none,” if applicable.

Local Share - Local share is subrecipients’ revenue generated from local sources such as, but are not limited to, taxing authority, funding received from state, county or municipal sources, other local or private grant awards and revenue generated from other internal activities. Capital consists of 88.53% federal contribution and 11.47% local match. Please note that source of local funds can NOT be from federal funds such as FTA Section 5310, 5316, or 5317 funds.

Maintenance Plan - Subrecipients are required to develop written maintenance plans for FTA funded facilities, vehicles, and equipment. The plan should identify the goals and objectives of a maintenance program and establish the means by which such goals and objective will be attained. In the maintenance plans, periodic reporting, maintenance record review, visual inspections, and maintenance audits should also be addressed.

Procurement Requirements - Recipients/subrecipients seeking federal assistance under the Federal Transit Laws as codified at 49 U.S.C. 5301 et seq. to acquire property or services in support of a proposed project is subject to numerous provisions of law pertaining to third-party procurement requirements.

Page 26 of 27

SAFETEA-LU re-codified FTA’s procurement requirements in 49 U.S.C. 5325. In addition, regulations promulgated at 49 CFR part 18 (Uniform Administrative Requirements for Grants and Cooperative Agreements to State and Local Governments) establish uniform administrative rules for federal grants, cooperative agreements, and subawards to State, local, and Indian tribal governments (private, non-profit organizations must comply with similar regulations in 49 CFR part 19). Provisions of the common rule pertaining to procurement requirements for FTA recipients that are governmental authorities are set forth at 49 CFR 18.36. Those requirements, as well as other FTA specific provisions, are also set forth in FTA’s Master Agreement, FTA MA(13) October 1, 2006, at Section 15, “Procurement,” and will be updated annually with issuance of each new Master Agreement. Finally, FTA has published additional guidance on recipient compliance with third-party procurement requirements within the most current FTA Circular 4220 and its “Best Practices Procurement Manual.” These regulations and guidance are intended to ensure full and open competition and equitable treatment of all potential sources in the procurement process including planning, solicitation, award, administration, and documentation of all Federally-funded contracts. Each recipient of FTA assistance to acquire property or services in support of its proposed project shall certify to FTA, in accordance with 49 CFR 18.36 that its procurements and procurement system will comply with all applicable third-party procurement provisions of federal laws, regulations, and directives, except to the extent FTA has expressly approved otherwise in writing. Any subrecipient that fails to provide this certification may be determined ineligible for award of federal assistance if FTA and State determines that its procurement practices and procurement system are incapable of compliance with federal laws, regulations, and directives governing procurements financed with FTA assistance.

Toll Credits - Toll credits provide a credit toward a project’s local share for certain expenditures with toll revenues. The amount of credit toward local share to be earned by State is based on revenues generated by toll authorities within the State. Under the provision of 23 U.S.C. 120(j), FHWA oversees the determination of toll credit within each state. For FTA, the effect of utilizing toll credits mean that FTA, in essence, provides 100% of the total net project cost. If subrecipients are planning to use toll credit for local share, you MUST coordinate with MPO and Caltrans before you submit an application to ensure the availability of the credit.

Page 27 of 27